title: Is there a prostate-specific antigen upper limit for radical prostatectomy?
abstract: OBJECTIVE
  • To assess the feasibility of radical prostatectomy (RP) in a series of patients with prostate cancer with very high prostate-specific antigen (PSA) levels by comparing the clinical outcomes of different PSA thresholds (20.1-50 ng/mL, 50.1-100 ng/mL and >100 ng/mL, respectively).
  
  
  METHODS
  • Within a multicentre European retrospective database of 712 RP in patients with a baseline PSA level >20 ng/mL, we identified 48 patients with prostate cancer with a preoperative PSA level >100 ng/mL, 137 with a PSA level between 50.1 and 100 ng/mL and 527 with PSA values between 20.1 and 50 ng/mL. • Comparisons between groups were performed using chi-square test, analysis of variance and Kaplan-Meier analysis with log-rank test.
  
  
  RESULTS
  • Ten-year projected cancer-specific survival (79.8% in the PSA >100 ng/mL group vs 85.4% in the PSA 50.1-99 ng/mL group vs 90.9% in the PSA 20.1-50 ng/mL interval; P = 0.037) but not overall survival (59.6% in the PSA >100 ng/mL group vs 71.8% in the PSA 50.1-99 ng/mL group vs 75.3% in the PSA 20.1-50 ng/mL interval; P = 0.087) appeared significantly affected by the different PSA thresholds. • At a median follow-up of 78.7 months, 25.8%, 6.6% and 8.3% of patients in the PSA level groups for 20.1-50 ng/mL, 50.1-100 ng/mL and >100 ng/mL respectively, were cured by surgery alone.
  
  
  CONCLUSIONS
  • Ten-year cancer-specific survival, while showing significant reduction with increasing PSA values intervals, remain relatively high even for PSA levels >100 ng/mL. • As part of a multimodal treatment strategy, RP may therefore be an option, even in selected patients with prostate cancer whose PSA level is >100 ng/mL.
authors.affiliation: Department of Urology, University Of Turin, Torino, Italy. paolo.gontero@unito.it
authors.forename: Paulo
authors.initials: P
authors.lastname: Gontero
authors.forename: Martin
authors.initials: M
authors.lastname: Spahn
authors.forename: Bertrand
authors.initials: B
authors.lastname: Tombal
authors.forename: Pia
authors.initials: P
authors.lastname: Bader
authors.forename: Chao-Yu
authors.initials: CY
authors.lastname: Hsu
authors.forename: Giansilvio
authors.initials: G
authors.lastname: Marchioro
authors.forename: Bruno
authors.initials: B
authors.lastname: Frea
authors.forename: Kathy
authors.initials: K
authors.lastname: Van Der Eeckt
authors.forename: Burkhard
authors.initials: B
authors.lastname: Kneitz
authors.forename: Detlef
authors.initials: D
authors.lastname: Frohneberg
authors.forename: Alessandro
authors.initials: A
authors.lastname: Tizzani
authors.forename: Hendrik
authors.initials: H
authors.lastname: Van Poppel
authors.forename: Steven
authors.initials: S
authors.lastname: Joniau
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D017430:Prostate-Specific Antigen